RCSEd Calls for Change to Major Trauma Care in Scotland

The Royal College of Surgeons of Edinburgh today released a report which shows that Scotland is falling behind the rest of the world in its provision of care for victims of major trauma.

The provision of care in the UK, for individuals who have suffered major trauma, has long lagged behind that of health services across the world, particularly in North America. Mortality for severely injured patients who are alive when reaching hospital is 40% higher in the UK than in North America. Recognition of this in England has led to a shift in healthcare policy; however, the situation in Scotland has not yet been addressed.

Trauma is the leading cause of death in all groups under 45 years old. In Scotland, it is responsible for approximately 1300 deaths per year. It is also the commonest cause of death in children and is responsible for more deaths in children and adolescents than all other causes combined.

As a prestigious international college with 20,000 members across the world, but with its home in Scotland, The Royal College of Surgeons of Edinburgh is in a unique position to examine current trauma care provision and identify potential future solutions. The College convened a working group comprising eminent practising surgeons and physicians and has, today, released a report that outlines their findings and proposals.

Ian Ritchie, Consultant Orthopaedic Surgeon at the Forth Valley Royal Hospital and Vice- President of The Royal College of Surgeons of Edinburgh, one of the members of the working group, explains:

"It is important to recognise that the focus of this report is on the provision of care to the small group of patients suffering from major trauma. In general, trauma care in Scotland is of a very high standard; however we can do better for those people who are very seriously injured. This report represents the beginning of a process which we hope will ultimately provide even better services for our patients in Scotland."

The report recommends the development of a trauma system across Scotland which focuses on reducing disability as well as mortality. Treatment of major trauma would be carried out at a small number of dedicated major trauma centres serving a wide geographic area. These centres would have access to all the necessary specialties on one site, and would be fully resourced with equipment and medical staff to deal with major trauma. Less severe cases could be dealt with in less specialised trauma centres, which would have a more regional focus and an intake from the local catchment area.

Mr Ritchie explains further:

"The model recommended by the report is equivalent to that in North America and the one being adopted in England. Major trauma treatment requires a precise set of skills and knowledge; it also needs to pull expertise from a wide range of specialties and resources. Under the current system in Scotland, major trauma patients are sent for treatment at the nearest local hospitals which may not have access to all the resources and specialisms needed."

In the past it had been thought that the system recommended in the report would not work in Scotland. This was mainly because the country's terrain, coupled with the way communities are dispersed, could mean longer journey times for patients needing to reach specialist care. However, it is now believed that, as long as the patient is stabilised, the length of the journey to final treatment is not as crucial as once thought.

"It is more important that the patient is delivered as soon as possible to a hospital and a team which is fully equipped to deal with the unique requirements of major trauma patients." says Mr Ritchie. "If necessary, under the new system, major trauma patients could be taken to a local trauma unit to be stabilised but it would be crucial they were then transferred to a major trauma centre as soon as possible. Experience suggests that major trauma patients and their families would accept a longer journey in the knowledge that they are in the best place and receiving the best care available."

Although the report is strong in its recommendation, it also stresses that more research, discussion and consultation is essential to analyse further the requirements and to determine the exact configuration of any resulting new system.

In conclusion Mr Ritchie said:

"The authors of the report believe that the model being used elsewhere in the world could indeed work in Scotland, and would ensure patients here have the best level of care possible. The next step should be to examine the situation in even greater detail, to determine exactly what a trauma system for Scotland could look like. We hope the report will stimulate discussion, at the highest level, between all those responsible for the delivery and practice of healthcare in Scotland and result in enhancement to major trauma patient care."

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